Do Patients Receiving Whole-Brain Radiotherapy for Brain Metastases From Renal Cell Carcinoma Benefit From Escalation of the Radiation Dose?

Rades, Dirk; Heisterkamp, Christine; Schild, Steven E.

doi:10.1016/j.ijrobp.2009.08.022

Cited by 22 publications

(17 citation statements)

References 29 publications

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“…Both local control and overall survival were significantly better after 40 Gy in 20 fractions than after 30 Gy in 10 fractions. These findings are in agreement with the results from our previous studies in patients who had brain metastasis from renal cell carcinoma, colorectal cancer, or malignant melanoma 26‐28. In contrast to the current study, those 3 previous studies included both patients who had a favorable survival prognosis and patients who had an unfavorable survival prognosis.…”

Section: Discussionsupporting

confidence: 93%

Dose‐escalation of whole‐brain radiotherapy for brain metastasis in patients with a favorable survival prognosis

Rades

Panzner

Dziggel

et al. 2011

Cancer

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BACKGROUND: Patients with brain metastases who have a favorable survival prognosis may benefit from intensive treatments, including neurosurgery and radiosurgery. However, many patients cannot receive such treatments, and whole‐brain radiotherapy (WBRT) alone is their only option. The most common WBRT schedule is 30 grays (Gy) in 10 fractions. In this retrospective study, the authors investigated whether these patients benefit from a dose escalation beyond 30 Gy. METHODS: Data from 109 patients who received 30 Gy in 10 fractions were compared with 75 patients who received 40 Gy in 20 fractions. All patients had a favorable survival prognosis. Both groups were compared for local control (LC) and overall survival (OS). Subgroup analyses were performed for patients who had less radiosensitive tumors (N = 27) and for other patients (N = 157). RESULTS: The LC rate at 1 year was 28% after 30 Gy and 44% after 40 Gy (P = .064). On multivariate analysis, the 40 Gy dose was associated with improved LC (P = .047). The survival rate at 1 year was 50% after 30 Gy and 61% after 40 Gy (P = .007). On multivariate analysis, the 40 Gy dose was associated with improved OS (P = .008). On subgroup analysis of patients who had less radiosensitive tumors, the 1‐year LC rate was 7% after 30 Gy and 38% after 40 Gy (P = .031); and the 1‐year OS rate was 40% and 73%, respectively (P = .008). On subgroup analysis of patients who had other tumor types, the 1‐year LC rate was 31% after 30 Gy and 45% after 40 Gy (P = .26); and the 1‐year OS rate was 52% and 59%, respectively (P = .08). CONCLUSIONS: Escalation of the WBRT dose beyond 30 Gy resulted in better outcomes, particularly for patients who had less radiosensitive tumors. Cancer 2012. © 2011 American Cancer Society.

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Section: Discussionsupporting

confidence: 93%

Dose‐escalation of whole‐brain radiotherapy for brain metastasis in patients with a favorable survival prognosis

Rades

Panzner

Dziggel

et al. 2011

Cancer

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“…Results from several studies have shown a median survival after WBRT of only 2 to 4.4 months. 20-23 Cannady et al 22 and Rades et al 23 have demonstrated that the survival of patients with brain metastases from RCC who are treated with WBRT have an RT dose response and a dependence on recursive partitioning analysis class. However, Rades and colleagues showed that even in the higher dose group the LC of the brain metastases at 12 months was only 35%.…”

Section: The Relative Radioresistance Of Rcc Is Overcome With Stereotmentioning

confidence: 99%

State-of-the-Art Management of Renal Cell Carcinoma

Mourad¹,

Dutcher²,

Ennis³

2014

American Journal of Clinical Oncology

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In the United States, renal cell cancer (RCC) is the third most common genitourinary tumor and the seventh most common cancer. Standard treatment of the primary tumor in RCC is complete resection by either a radical or partial nephrectomy which can be done as an open procedure or laparoscopically. Given the increasing incidence in the diagnosis of early-stage RCC and the toxicity and invasiveness associated with surgery, less invasive options (eg, radiofrequency ablation) have been used recently as an alternative. Although conventional radiotherapy plays a role in the palliative setting, its role is otherwise limited. This is partly because of the in vitro and clinical data showing that RCC is relatively radioresistant to radiotherapy. The advances in immobilization and image guidance have led several investigators to consider stereotactic techniques to overcome this resistance with impressive results in the metastatic setting. Recent retrospective and prospective phase II trials of RCC stereotactic body radiotherapy have shown excellent local controls up to 90% to 98%. Given these results and the noninvasive nature of stereotactic body radiotherapy this modality should be further evaluated as a treatment of choice for the primary RCC tumor. Although RCC is also resistant of conventional chemotherapy agents, exciting recent advances have emerged in the treatment of systemic disease with the development of targeted agents in addition to immunotherapy-based treatments. In the current critical review we discuss these emerging trends in localized and systemic treatment as well as possible interesting combinations of the 2 modalities.

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“…Subsequent to these systematic reviews, Rades et al have reported two retrospective cohort studies suggesting that dose escalation of WBRT beyond 30 Gy in ten fractions improves overall survival of patients with metastatic melanoma and renal cell carcinoma [4,5]. A randomized study of 40 Gy in 20 twice-daily fractions compared with 20 Gy in 4 daily fractions showed that patients treated with the higher dose twice-daily treatment had better intracranial tumor control (intracranial progression in 44 % with 40 Gy in 20 twice-daily fractions vs. 64 % with 20 Gy in 4 daily fractions, p00.03) with similar quality of life measures using the European Organization for Research and Treatment of Cancer Quality of Life 30-item questionnaire.…”

Section: Whole Brain Radiotherapymentioning

confidence: 99%

Conventional radiation therapy for brain metastases

2012

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Conventional radiotherapy in the form of whole brain radiation treatment has been a longstanding treatment for brain metastases, and it continues to provide effective palliation as monotherapy and in combination with local and systemic treatments. Advances in systemic therapy have improved survival with metastatic disease, and in those patients with better prognostic factors, more aggressive local therapeutic approaches for brain metastases appear to benefit their survival and intracranial tumor control. Increased treatment intensity and longer survival following treatment of brain metastases have raised concerns about persistent treatmentrelated neurocognitive toxicities and the resulting impact on quality of life. Technological advances in conventional radiotherapy planning and delivery have led to novel approaches that may increase intracranial tumor control while minimizing the treatment-related toxicities of therapy. These innovative approaches include intensitymodulated radiotherapy, new image-guidance techniques, and volumetric modulated arc therapy, which allow for the delivery of whole brain radiotherapy with integrated boost treatment to the visible disease while sparing the hippocampal regions or delivery of hypofractionated radiotherapy to larger metastatic targets that may not be amenable to radiosurgery boost or salvage treatment.

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Do Patients Receiving Whole-Brain Radiotherapy for Brain Metastases From Renal Cell Carcinoma Benefit From Escalation of the Radiation Dose?

Cited by 22 publications

References 29 publications

Dose‐escalation of whole‐brain radiotherapy for brain metastasis in patients with a favorable survival prognosis

Dose‐escalation of whole‐brain radiotherapy for brain metastasis in patients with a favorable survival prognosis

State-of-the-Art Management of Renal Cell Carcinoma

Conventional radiation therapy for brain metastases

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